Der Internist

, Volume 53, Issue 7, pp 810–816 | Cite as

Therapeutische Strategien gegen die Progression der Niereninsuffizienz

Schwerpunkt

Zusammenfassung

Die chronische Niereninsuffizienz ist eine häufige Entität. Unabhängig von der Behandlung der Grunderkrankung sind Maßnahmen identifiziert worden, die das Fortschreiten zur dialysepflichtigen Niereninsuffizienz verlangsamen können. Die wichtigsten Maßnahmen sind dabei die Senkung des Blutdrucks und der Proteinurie. Nachdem die mögliche Gefährdung der Patienten durch eine zu starke Blutdrucksenkung in verschiedenen Studien offensichtlich wurde, werden die bisher formulierten niedrigen Blutdruckziele in Zweifel gezogen. Es ist daher eine individualisierte Therapie notwendig, im Rahmen derer kardiovaskuläre Vorschädigungen und die Gefahr einer Progression der Niereninsuffizienz im Einzelfall abgewogen werden. Weitere Einflussfaktoren, die modifiziert werden können, sind die Diabeteseinstellung, Fettstoffwechselstörungen, die renale Anämie, Harnsäure, Vitamin D, die Eiweißzufuhr und der Nikotinabusus.

Schlüsselwörter

Chronische Niereninsuffizienz Hypertonie Proteinurie Renin-Angiotensin-Aldosteron-System Diabetes mellitus 

Therapeutic strategies to prevent chronic kidney disease progression

Abstract

Chronic kidney disease (CKD) is highly prevalent. Independent from the underlying disease, measures capable of decreasing the progression of CKD have been identified. Lowering of blood pressure and proteinuria are most important. As the potential risk of aggressive blood pressure-lowering strategies has become obvious, the current very low blood pressure goals are doubted. Thus, patients have to be treated individually taking into consideration each patient’s preexisting cardiovascular damage and the risk of CKD progression. Additional modifiable risk factors are blood glucose in diabetic patients, lipids, anemia, uric acid, vitamin D, protein intake, and smoking.

Keywords

Kidney failure, chronic Hypertension Proteinuria Renin-angiotensin-aldosterone system Diabetes mellitus 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Abteilung für Nieren- und HochdruckerkrankungenMedizinische Hochschule HannoverHannoverDeutschland

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